| NPI | 1700100229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist (Licence: TX Q7253) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: OK 30476) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2020-02-18 |